Abstract
ObjectivesMajor depressive disorder is a frequent and serious disease, which can result in suicide. Treatment resistance is frequent in this pathology and actual antidepressants need a few weeks before having a clinical efficacy. Ketamine is an NMDA antagonist used in anaesthesia for decades, and has shown since several years a fast and efficient antidepressant effect in patients with treatment-resistant depression. MethodsThe aim of this review is to investigate the state of the art of the scientific literature about the antidepressant effects of ketamine. ResultsA subanaesthetic infusion (0.2 mg/kg) of intravenous ketamine reduced depressive symptoms for both unipolar and bipolar depression in many randomized controlled trials. Clinical effects can be observed as soon as 4hours after treatment and last for a few days, which has been confirmed in recent meta-analysis. This molecule could also potentiate the efficacy of electroconvulsive therapy and have a neuroprotective effect in such treatments however results are controversial. Ketamine also showed a fast and specific reduction of suicidal ideation. Mechanisms of action of ketamine are still poorly known. Its partial NMDA antagonist action modulates the metabolism of glutamate, and thus stimulates neurotropic systems such as BDNF or mTOR resulting in an increased brain neuroplasticity. Anti-inflammatory or analgesic effects may also explain ketamine's efficacy. This treatment can provoke dissociative effects and cardiovascular events which are reversible within a few hours. While promising, ketamine's efficacy has a limited duration in time. ConclusionKetamine has a fast antidepressant effect in both resistant unipolar and bipolar depression. However it seems difficult to use it as an antidepressant in common practice due to its short duration of efficacy and adverse effects: studies are in progress to develop new molecules aiming the same molecular pathways. Ketamine could be a useful treatment of acute suicidal crisis in major depressive disorder and upcoming researches should help understanding its mechanisms of action as an antisuicidal medication.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
